I.O.M. : Mhmoires & I'Accouchement BY Donald S. Fredrickson An essay prepared by invitation in connection with The twentieth anniversary of The Institute of Medicine June 12, 1990 Quotation from or reproduction of this ms. only upon permission of the author Jntroduction I've a good-sized personal investment in the history of the Institute of Medicine. It includes one of the important turning points in my career. Someone might view it as merely the briefest stopping point, considering that I served as IOM president for only a year. But I had been exposed to the attractions of an "academy of medicine" well before I walked away in 1974 from a twenty-year career in clinical investigation and a large laboratory at NIH in the peak of its productivity. At the time, I explained the move as resulting from an irresistible compulsion to listen to "other drums", the yielding to a powerful urge to explore the other sides of my profession as a physician. Here follows a description of what happened. Birth of an IdeR By the time Irvine Page's first editorial appeared in the summer of 1964, I, like many others, had already heard the originator spell out his reasons for the need for an Academy of Medicine." In the early 60s I was a member of his Stouffer Prize Committee, which gathered annually in Cleveland to decide who should be that year's recipient(s) of a then gigantic reward of $50,000 for discovery relating to either atherosclerosis or hypertension. This bolus of recognition tossed upon an embarrassingly circumscribed area of medical research was provided by Vernon Stouffer, the food magnate. The idea was generally iom memoir de fredrickron acknowledged to have been inspired by Irv Page. Page's personal crusade for an academy of medicine was something much more serious than the Stouffer Prize. One had only to listen briefly to his arguments to believe that his was a genuine, deep belief that medicine was a singular profession rising out of a tradition to serve humanity through a combination of scientific, moral and social actions. He considered that an institution was needed to honor the intrinsic values or ideals of medicine, to save them from depreciation, and to help sustain their humanitarian purpose. By the end of the 6Os, Page had collected a distinguished company of supporters who shared his ambition. I was not among those who attended the first organizational meeting of about twenty people at the Cleveland Clinic in January 1967. Nor was I a member of the Board on Medicine that was set up in June of that year by president Frederick Seitz and the Council of the National Academy of Science for the purpose of founding a National Academy of Medicine. I remained among numerous other cognoscenti from the worlds of academia and biomedical research who were privy to the ensuing action, however, including the disagreements and the disillusionment of some of the founders by the time the Institute was chartered in 1970. iom memoir da fredrickaon 2 Joinian the Council I became a member of IOM in 1971, the first year of its existence. In the autumn of that year I received a telephone call from Julius Comroe in San Francisco. Julius was getting up a petition and wanted to know if I would accept nomination as a candidate for the Council of the Institute. He said that he and certain other founders were concerned that another scientist should be added to the list of nominees for Council at the next election. I agreed to run and joined the Council in 1972. John Hogness was in the second year of his term as the first President of the Institute of Medicine. I have several clear recollections of my experiences on the Council. The quality of the members was high. *' Drawn from a broad pool of minds and experiences, their talk was heady, the debates cogent and often highly literate. There was a rich mixture of the dialects and ethics operative in the world outside the laboratory walls where I had theretofore spent most of my time. In the frequent Council meetings one encountered the better sides of the law, economics, commerce, as well as a broad selection of the healing arts and different disciplines of science. We councilors felt that we shared a perch with an unparalleled view of the complex field of human health. We also savored the anticipation of practical engagement with the many serious discrepancies between need and promise existing in so rich a land as America. This exposure stimulated receptors I had not much used iom memoir Q fredrickron 3 before, and the experience was addictive. Other more disturbing sensations impinged on the enjoyment. We were aware that the terrain upon which the brand new Institute stood was unsettled, and there was a premonition of seismic disturbance, the results of tensions that then existed between the leadership cadres of IOM and the parent NAS. In placing the epicenter of this instability in the office of the new president of NAS who succeeded Seitz in 1969, I must tender an offer of apology. This is not the space in which to attempt either a full explanation of the affairs of the "Academy complex" in the early 1970s or a proper defense of president Philip Handler's execution of the difficult role in which he was cast at the birth of the Institute of Medicine. A brief sketch of the situation is unavoidable, however, to frame my own small part in the whole. Growinn Painq. In 1969, the Academy was still in the process of assimilating the new National Academy of Engineering. Created in the early 6Os, the NAE had undergone development that foreshadowed the ontogeny of the future IOM. Seeking recognition of achievement in their profession beyond that available in the restricted election of members to the NAS, a group of engineers had decided to create their own academy, largely but not exclusively for honorific functions. There was much concern that such a separatist move would particularly ill-serve the needs of the National Research iom memoir dr fredricbon 4 Council. The latter had been for years the principal arm for carrying out the numerous and important studies for the government mandated by the NAS charter going back to Abraham Lincoln. After much negotiation, agreement was reached on a way to keep science and technology together in the same House. A key condition of the partnership struck between NAS and NAE was that most of the business of the two academies would be done through NRC, and the Governing Board of the Research Council would be constituted of members from both bodies. Philip Handler was burdened not only with this crucial process of amalgamation, but also with a long-overdue re-organization of the NRC itself. He was pouring both imagination and considerable energy into the restructuring of this sprawling house of agencies and groups that had slowly been growing more chaotic and independent as its load increased over the years. The oversight by the different classes of academicians had proved insufficient. New commissions and assemblies were now being created that were intended to take over many of these responsibilities. A New Accommodation. Into this mise-en-scene there was suddenly thrust the proposal for an Academy of Medicine. For many in the NAS leadership there was an unpleasant sense of having to begin all over again, a distaste perhaps compounded by wariness of a population they understood even less well than engineers. iom memoir da fredrickeon 5 While it had a few distinguished physician-scientists among its members, the NAS had never pretended to recognize physicians per se. In the conservative views held by many NAS members, physicians were in the main to be seen as artisans, technicians, or high-priced professionals whose qualifications were not measurable by the traditional standards of the Academy. More disturbing, however, was the activist bent of this new group of would-be academy founders. They insisted that members be elected for limited terms under a condition of agreement to serve in the projected heavy work of the new organization. It was also obvious that membership could not be limited to physicians; a far broader representation of peoples and professions would have to be chosen. After his first meeting with Handler, Page summed up his perception of the initial reactions of the new NAS president to the whole idea: "to him, @'a National Academy was non-negotiable as was any independent co-equal organization under the NAS charter". " Nevertheless, Handler, a biochemist, and most of the leadership of the Academy were left uncomfortably aware that, compared to all the other disciplines, this half of the twentieth century was most likely to be dominated by revolutionary growth in the life sciences. Moreover, the biological and behavioral sciences were only part of a sweeping spectrum of technological developments, professional and para-professional education, social responsibilities, and issues of service and economics that could not be ignored by an eminent quasi-public institution such as the iom memoir de fredrickaon 6 National Academy of Sciences. If the Academy complex did not find place for "IOM@*, it would have to create its competitor. The key question was how to fit the new creature into the box. A number of the conditions for co-existence were still being negotiated and resolved as the IOM began the first years of its existence. The accommodation of IOM had created two special problems. It wished to run some studies with its own staff, contrary to the new thrust for all programs to be overseen by the NRC Governing Board. The failure of the IOM to submit its studies to the supervision of the Board was considered a serious threat to the 18symmetry*' of the newly-constructed Academy structure. This also meant that the NAS Council must go through the arithmetic again of apportioning representation of another partner to the Board. The outcome had to appeal to the sensitivities of all the groups at interest, while assuring retention of an executive majority by the NAS . To add to the potential for conflict, an Assembly of Life Sciences was chartered in 1973-4 to oversee the NRC action in the biological sciences-- including the fractious, quasi-independent Division of Medical Sciences. The sentiment of the NAS leadership was thoroughly dis-inclined to hand over to IOM the sciences most relevant to its work and there was a general feeling that the Institute ought to be content with a residual, collectively called @'health.88 iom memoir da fredrickeon 7 Thus clouds still hung broodingly over the busy House of the Academy in mid-1973 when John Hogness announced to the Council of IOM that he had received an invitation earlier identified as the one offer he would be unable to refuse. He planned to stay until mid-1974, when he would assume the presidency of the University of Washington. The Council began to prepare a slate of candidates for his replacement to be placed before the president of the NAS. Pressure for Solutions One of the high-water marks in the history of the long struggle to establish the "Academy of Medicine" was the dispatch of a letter from Phil Handler to Hogness--who was now a lame duck- -and the IOM Council on November 7, 1973. In it, the NAS president expressed his concern that long discussions had left unresolved serious questions about the modus onerandi of the Institute within the Academy complex. I recall that formal acceptance by IOM of the assignment of two among 13 representatives to the NRC Governing Board was one of the outstanding issues. In his letter, moreover, Phil Handler had suggested the IOM Council must choose one of three "scenarios II in adjusting to the wishes of the NAS Council and the new design of the NRC. One of these was the unacceptable possibility that the IOM might function only as an "honorific body". John Hogness called for a special IOM Council meeting to consider his answer to this challenge. I will not attempt here to provide details of the accommodations eventually reached even iom memoir dr fredrickron 8 though they are important parts of the definitive history of the institutions involved. I will turn instead to a brief record of more personal involvement, including the beginning of my acquaintance with Philip Handler a few weeks later. */ A Meetinn with Handler. I had been elected to membership in the NAS in the Spring of 1973, but Phil Handler and I were strangers until November 20 of that year when he invited me to his office. As I sat down, Phil said, 'IThe Council of the IOM thinks I ought to talk to you about John's (Hognessl) job." Phil explained that his only awareness of my views of the Institute was an expression of belief on the floor of an IOM meeting that the Division of Medical Sciences should be under the supervision of IOM. He then reminded me that the old Board on Medicine had repeatedly refused to accept responsibility for "that can of worm~'~ before, and implied that IOM had forfeited any further chances of oversight through the default of its progenitors. Our conversation that day lasted nearly three hours, and included a long discussion of my analyses of the choice of the "three scenarios" he had recently offered IOM in his recent letter. I received his protest that he had not meant to cause alarm, and certainly no crisis, by their presentation. Before our leaving that subject, however, I told Phil that it was necessary for the Councils of IOM and NAS to reach agreement on IOM status before I could further consider standing for the presidency. iom memoir dr fredrickron 9 Among the topics we discussed was also the concern of the NAS Council as to how IOM would establish criteria for its membership in accord with the heterogeneity of representation demanded by its charter. I defended those stipulations and insisted that the pluralism of health issues required admission of members whose qualifications couldn't be measured in the traditional NAS manner, that 'ecumenism' was essential for meaningful activity in the health area, and that what he perceived as 'noise in the system' was a redeeming and necessary sign of life [in the IOM]. We parted with what I interpreted as mutual respect for each other's positions. I was launched on a long path of getting to know Phil Handler, and that acquaintance would emerge much later, on my part, in affection and admiration for his dedicated, if sometimes ostentatious stewardship of the Academies. Decisions In the next several weeks I talked to John Hogness, who I feared was possibly much too optimistic about the strength of the Charter as security for the integrity of IOM. I expressed my admiration for the diplomacy and restraint he had displayed during this period. The next several days I also visited with Roger Bulger, the executive officer, and many of the staff of the still tiny IOM, the majority housed on the third floor east of the NAS Building.'/ I hastened to assure Roger, that if I were to become president, I would make it a condition that he stayed. I never ceased to admire his flair for patient understatement, steadfast iom memoir dr fredrickson 10 loyalty, and invaluable partnership in sharing the command of the daily affairs of a ship on an overly-long trial voyage. I also had several brief meetings with Phil Handler about "perks and amenities" and other details on which I needed his reading. On December 12, the IOM Council met to discuss the Handler letter and work over a reply from John Hogness. About a week later, Roger read a draft to me over the telephone and I suggested one or two minor changes. I left town the next day with my older son Eric. Our itinerary included first, Switzerland--for twelve days skiing in the Oberengadine and, I hoped, some thinking- time to sort out the rest of my life. We were then to fly to Finland and Sweden where I was invited to give some lectures on my specialty of lipoproteins before returning home. The Ouestion My diary records: "Helsinki, January 7-9, Hotel Vaakuna, saunas, and heaps of Johansson's temptation." From other notes I've pieced together it seems that on the first day we were taken to the famous old restaurant Konig by Essko Nikkila and his team of lipidologists. There we spent an unforgettable evening in a room revered as the favorite meeting place of Sibelius and his cronies. We did honor to the spirit of the immortals with a feast of ptarmigan, ending with brandy and cigars. What better life could there be than full membership in the fraternity of science? At the hotel a message: Handler had phoned. Now I should have to answer both his question and my own. I called back, the voice iom memoir da fredrieknon 11 at the other end was impatient, perhaps imperious ( I would come to understand this mannerism as the shield hiding a sensitive nature.) Our dialogue was brief. II I need to know by next weekend." II I understand: first, however, I am most interested in your answer to the Hogness [December] letter." "1 see no trouble with this and had asked two members of the [NAS] Council who also see no trouble with it.*@ II Good, this is most important to me." Back at NIH by the 14th of January. Culliton speculates in Science: "Fredrickson may head 1OM.l' On the 18th, after much final discussion with family, I decided in the affirmative and phoned Phil Handler in the afternoon. 'IHe seems genuinely pleased," I recorded. "Would I also be tomorrow?" Commencement The Spring meeting of IOM was held on May 8, 1974. John Hogness was presented an illuminated scroll of tribute. I gave a brief inaugural address, and Philip Handler, V'lacking a mace or similar symbol of authority to represent the Institute presidency," presented me with my telephone credit card. 6/ To the assembled members, I had spelled out what I thought that mandate of the Institute was: I' Our commitment is to lend the scientific method to thd direction of a whole social movement. There have been many encouraging signs of acceptance of the Institute of Medicine as uniquely qualified to perform this public service. . . And the acceptance, the success, iom memoir de fredrickson and the meaning of this organization rests upon its having the essence, not Tlmerely the appearance, of nonpartisan objectivity." As I now re-read my remarks on that occasion, I note that I inserted an apology near the end of my oration: "1 have subjected all of us to the risk of drowning in metaphor to emphasize the scale of our commitment". This disclaimer ultimately failed to spare the rhetoric of the second president of the IOM from the merciless parody it richly deserved. */ The Too-Brief Seaso O . I had concluded my inaugural remarks with a sincere expression of what I had come to believe: I' that criticality and skepticism and the orthodoxy of iethod that one encounters in the biological sciences is transferable to problems more social or economic in content. . . the ferment of scholarly colloquia, the joys of discovery and the pleasure of labor to better the human condition are to be found no $ess in this Academy than in the laboratory or clinic." . Indeed, I found that this prediction was true in the brief season that I was to work in this new vineyard. There many new things to learn. Shortly after I had accepted the position and before my inaugural, I accompanied John Hogness on a round of solicitation of donors for funds to keep the new organization in a state of solvency. It was something for which I had no prior training, having spent my entire career in the federal government, where the pitch for funds is a very different art form. The skills of my iom memoir dr fredrickaon 13 successors in matching the aims of philanthropic organizations to the requirements of a public service organization with little or now endowment has my full respect. Thanks to the patience and generosity of several major foundations we had enough success in this task of institution preservation to remain solvent during my tenure. Among my prized possessions is a work by the gifted cartoonist Vint Lawrence, in which my visage is discernible, bounded by a gigantic "K" , two J's, and a large fragment of a watermelon, easily recognized symbols for three of our major supporters at that time. Because the staff of the IOM was increasing and space had become a premium, our efforts to achieve a higher ration of the bulging Joseph Henry Building was unsuccessful. The alternative offered by the Academy was indeed far more exotic. It had leased a portion of the Watergate Building, assigning to us the suite involved in a recent, most infamous crime. The space allotted for the use of the president had been the office of one Mr. Lawrence O'Brien, an important official of the Democratic party. Unfortunately, the NAS had already placed a partition in these quarters, rendering them less than opulent. But the famous door that had been left open was unchanged. Business was not infrequently interrupted by tourists attracted to the site. To assist their gaining the historical instruction available here, Wally Waterfall and I prepared a memorial plague, and had the inscription edited by Phil Handler himself. I presume the plague iom memoir da fredrickeon 14 and its message are still attached to the door. " These capers aside, Phil Handler and I also got to know each other better. Reflecting upon those early days at a dinner in honor of Phil and Lucy Handler (1981) I recalled: II I can't say that our association at first was easy or ihit it was ever really intimate, because whenever we approached each other, we each seemed to be carrying a heavy piece from two different structures, the ends of which we were constantly trying to fit together to work harmoniously. . . 11 That first few months were spent in making rules. Hiv;? you read Piaget on how children learn the rules of games, make them up, and then unlearn them? That was the nature of the early relationship of the Academy and the IOM. The Upper Child, the Academy, and the Upstart Baby were trying to play a game . . .to govern the NRC. . . to survive the wicked tyrannies of the report review process. . . while pretending to be on the same . . It helped us get to know each other better. lg/lanem The more solid achievements of this relationship, the development of Council, staff and membership and the projects undertaken during my presidency deserve better treatment than I am able to give in this memoir. Alas, I had not yet completed the first six months before events conspired to create another fateful diversion in my career. Ominous Sinus. The Nixon years had been accompanied by unusual perturbation of the NIH and the academic community. Someone referred to the IOM at that time as a *#camp of exiles from the administration", and perhaps our most prominent fugitive when I took over was Robert Q. Marston, who had succeeded James A. Shannon as Director of NIH. Marston was serving as a Distinguished Scholar in Residence of the iom memoir dr fmdrickron 15 Institute while sorting out his future options after being forced to leave his post at NIH. The cause had been his resistance to the actions of Administration and the Congress in the passage of the National Cancer Act of 1971. A schism of the NIH into two bodies, one devoted to cancer research and the other to all the rest of medicine and biology had been narrowly averted as this controversial bill went through passage by Congress. The resulting politicization of the position of the director, however, had left an indelible scar. Those of us who had begun our careers at NIH had believed that high science could be done in the midst of government, with preservation of the academic style. The year 1973 had barely begun when Marston's chair become vacant. During this year the IOM Council debated whether it should review the five-year cancer research plan which had been mandated by the National Cancer Act. It decided that the plan encompassed most of biology, if not all of life, and could not be analyzed objectively. Neither could all the passion be cooled by pure reason; there was more upheaval to come. In May, 1973, the Assistant Secretary of Health Dr. Charles Edwards introduced Dr. Robert S. Stone as the new director of NIH. When I left NIH in May, calm had recaptured the campus. By autumn I was recieving evening phone calls from the '1ASH8V that made it clear he and the new NIH director were at loggerheads. Edwards signaled that he was going to remove Stone from his position and, one night in December, inquired of my interest in returning to iom memoir dr fredricbon 16 Bethesda. I protested vehemently that I was now responsible for IOM and that nothing could be worse than another turnover of NIH directors as a result of political action. The director's position was unfilled again with the dawn of 1975. Just as abruptly the position of the ASH was vacant. 11/ Suddenly, the fabric of my presidential chair began unraveling. On January 7, 1975, I had a call from a Mr. Howard Cohen at the White House. 12/ "Your name is on lists of candidates for both Assistant Secretary of Health and for Director of NIH*', said Cohen. Would I be willing to come over for a chat?. Apparently my name had "been added to the lists", by Edwards and Ted Cooper his assistant, and by others who notably included IOM staffers Ruth Hanft, and her assistant Barbara Cohen (the latter by curious coincidence being the wife of Howard Cohen.) "Betrayed by my own troops", I thought, but the members of the fifth column soon confessed they had not failed to notice my eyes glowing with old love whenever I described the NIH in IOM staff meetings. On January 9 --exactly a year to the day after Handler's call to me in Helsinki-- I found myself in room 153 in the Old Executive Office Building. As Howard Cohen and I sat down to talk, conflicting loyalties had my mind in turmoil. I dismissed any interest in talking about the ASH position and added that consideration of the NIH position depended upon three things. First was the question of how to protect IOM from destabilization by departure of a leader whose five-year term had barely begun. iom memoir de fredrickaon 17 Secondly I demanded to know what the Ford administration intended to do about eliminating the politicization of the NIH. Finally, I said I would have to withold agreement to any offer until I knew who would be my superior, the new ASH. There have been administrations in which this last bravado would have halted my career at the gate. Cohen, however, kept up a running report on who was now being considered, and I found I had acquired unexpected leverage, a power I used sparingly, but at least once. One day I was briefly introduced to Bill Walker, Cohen's superior in the head-hunting expedition. He wanted to know what IOM was and listened to what I considered NIH's problems. They both concluded that I should now talk to HEW Secretary Weinberger. A Visit to the DeDrrtment. The Secretary's invitation came swiftly, in accord with the pace of all the events in this unfolding scenario. At two o'clock on the 13th of January I entered his office in the HEW North Building. I was reminded by the familiar doors and divans that I had been summoned here before for a similar reason. It had been eight years since I had convinced John Gardner, that most admirable and persuasive of men, to drop me as a candidate to succeed James A. Shannon, due to retire in 1968, after 13 outstanding years as NIH Director. Shortly thereafter, Secretary Gardner took leave of President Lyndon Johnson's cabinet. His undersecretary, the late Wilbur Cohen, called me back for 'lcouch sessions" to overcome my adverseness to upward mobility. My objections centered around my iom memoir de fredrickaon 18 recent return to the laboratory full-time after serving a year as director of the National Heart Institute. I held firm to my ambition to remain there despite the devitalizing effect of numerous proffered cigars offered by my second interrogator. 13/ Caspar Weinberger's reputation as "Cap the Knife" when head of the OMB had proceeded him to HEW. I was not surprised to see him wearing a suit of mortician's black. Maroon socks over the ends of long underwear were visible beneath his cuffs, and I noted that the thermostats were now set low in the upper reaches of HEW. But I also found the Secretary to be less than fearsome. He began talking quietly, sometimes answering his own questions. Did I know the present Institute directors? Was I willing to consider the NIH directorship? After ten minutes of such interchange I indicated I had some specific inquiries. I still have the four sheets of yellow foolscap on which I had drawn up the issues I intended to press upon my interrogator. The sheets remained in my pocket, but I methodically got through every point: my views of the NIH-NC1 problem; did the Secretary intend to leave peer review intact? Would he now leave appointments of advisors to the scientists? Was he aware of the need for more training funds? And, as a final thrust, did he not think that a presidential statement to reassure the scientific community should be emitted? The Secretary listened patiently, and nodded at various places. I felt I had been heard, although without victory, as he rose and it was time for me to leave. The departing ASH, Dr. Edwards, was there most of the time iom memoir ds fredrickson 19 and we afterwards went over some of my points again. The Waiting Game. In the first break in this schedule I went to see Phil Handler. He reported that Secretary Weinberger had told him that the choice requires a "scientist with impeccable credentials-- someone like Lewis Thomas or youl@. @@It's not a job; it's a cause,ll I said. I found myself attempting both to explain to him how one could leave IOM so quickly, and to myself, how the loss of salary and amenities simply had to be forgotten in the decision. Phil nodded, did not argue, and asked me when I would have to leave. We agreed, that if the decision was inevitable, I should try to delay my departure until the end of June. The next several days I was in New York at Macy meeting on biomedical research run by Jim Shannon."' Lew Thomas was one of the speakers. He fixed an eye on me and uttered: "Mirabile dictu"- -do it". Within a few days I entertained new members of the IOM Council at dinner at the Academy. Leon Eisenberg, Robert Ball, Lee Shore, Alain Einthoven, Mel Glasser, Bernard Greenberg and Robert Haggerty were there. I guiltily said nothing about the rising probability of my possible defection. The next morning, before the Council meeting, I breakfasted with Adam Yarmolinsky, whose legal talents and tenacious defense of the Charter IOM had been invaluable to the Institute from its inception. I admitted to him I might be iom memoir da fredrickron 20 leaving. Adam argued that I would have a greater influence on science if I stayed at IOM. Walking from his hotel to the Council meeting, we continued the debate, but I turned to the troublesome matter of the Charter being silent about who should govern the Institute in the absence of a president. Adam concluded we should select a vice chairman. We would have to preclude that person from running for the presidency and have the approval of the President and Council of the NAS. iom memoir ds fredrickeon 21 At my request, the Council went into executive session and I spoke squarely about the rumors that had begun to fly about Washington. Bill Baker spoke in favor of my going to NIH; others expressed fear for IOM and urged me to stay. Lewis Thomas had already declared his position in the matter. Guido Calabresi, elegant but eminently practical, moved that a Vice Chairman be appointed. Provision for such an appointment was made. In the last week of February, I was informed by the White House that President Ford had been handed a staff memorandum containing four nominees for the Assistant Secretary position and one for NIH. On Friday the 28th, a call came from Howard Cohen to say that the president had approved Cooper and Fredrickson. Within ten minutes Secretary Weinberger called with the same message, adding the @lyou need to get to NIH soon because of the morale problemgl. Officially, of course, nothing had happened. The security clearances, the conflict-of-interest papers, and other untied ends always mean the keeping of official silence about presidential appointments, from lowest to high. The Secretary obtained permission to spill the beans, however, in an appearance on April 19 before hundreds of NIH alumni under a great tent pitched on the campus. There was a roar of relief upon announcement that the vacant chair would soon be filled and politics subdued. During the last week of April Cooper and I paid the requisite courtesy visits to the Hill, and our confirmation hearings before iom memoir de fredrickaon 22 the Senate Health Committee took place on May 2. "I President Ford, whom neither Cooper nor I had seen during the entire period of recruitment, came to NIH on July 1, 1975, and stood by as Caspar Weinberger administered the oath of office to each of us. Formal Farewellq. On April 25 I had addressed a formal letter to the Council: `I My decision represents a choice between two i&it&ions for which I have great affection and whose causes are both high in public interest. I have chosen the one whose immediate needs seem more critical." I' lie; I am not unmindful of the potential for harm that in twice changing the presidency of IOM during the first four years of its existence. Had I any question of the ability of the IOM to survive its President, I would have chosen to remain." I also expressed in this note my deep gratitude to Julius Richmond who had agreed to serve as the vice-chairman of the IOM Council until a new president could be recruited. It was on April 23, that I had also made my first and last report on IOM to the annual meeting of the NAS. Distinct among my memories of that occasion is Phil Handler's deep and unmistakable chuckle at my closing remark: I9 I have confidence that we will meet our obligations. . . despite the transitory image of our Presidents." * * * That confidence has proved to have been correct, and I acknowledge my share of our debt to John Hogness, David Hamberg, Fred Robbins and Sam Thier, who have been the principle stones iom memoir da fredrickaon 23 bearing the weight as IOM has risen to its present height. It is beyond my capacity to recognize singly all those who contributed to the noteworthy parts of my own brief appearance in the twenty years of growth and development that are being recognized on this anniversary. To Irvine Page, and others among the surviving founders who continue to compare their earlier conceptions with the present reality, I offer my belief that, in the form and function of IOM, an academy of medicine now exists that guards the ancient ideals and values of the healing arts and is working hard and successfully to maintain the implicit promise to carefully use the best of in the interest of science humanely for the health of people everywhere. iom memoir dr fredrickson 24 NOTES 1. 2. 3. 4. 5. 6. 7. 8. 9. IO. Irvine Ii. Page. Papers 1917-1989; MSC 386, Box 1. Division of the History of Medicine, National Library of Medicine. The members who served on the IDM Council during 1972-4 included: William 0. Baker, Ivan L. Bennett, Jr., Guido Calabresi, Martin Cherkasky, C. Gardner Child III, Clifton 0. Dumnett, Lloyd C. Elm, Rashi Fein, Loretta C. Ford, Donald S. Fredrickson, Robert J. Glaser, Bernard G. Greenberg, David A. Hasburg, Houard H. Hiatt, Alvin J. Ingrern, Irving II. London, Walsh McDermott, David Mechanic, Dorothy P. Rice, Henry U. Riecken, Julius Richmond, Ualter A. Rosenblith, Ernest Saward, Ruth M. Schlotfeldt, Nathan J. Stark, Eugene A. Stead, Lewis Thomas, Adzns Yarmolinsky, Joseph F. Volker, Alonzo S. Yerby, and Kerr L. Uhite. Irvine H. Page. Papers 1917-1989; USC 586, Box 2, NAS-BOIL Correspondence, Sept.-Oct., 1969. Division of the History of Medicine, National Library of Medicine. During the early 19708, 1 began compiling a diary of more than ordinary events. At first I used U.S. Government issue green cloth-bound notebooks in uhich many of us kept cur lab notes. It uas in the first and second voluaes of these "Green Diaries 11 that my conversations uith Phil Handler and recollections of certain other events in this essay were recorded. Among those me&ers of the staff visited at that time were: Bob Ball (OOScholar in ResidenceP), Martha Bloxall, Roger Bulger, Lew Cranford, Jean George, Jim Goodnan, Karen Grimn, Ruth Hanft, Ingar Hermann, John Ingle, Bob Marston (PDistinguished Scholar"), Paul Rettick, Dick Seggel, Larry Tancredi, Ualter Unger, Jim Veney, Ually Uaterfall, and Karl Yordy. Joseph Perpich, I&IO became a member of the staff in 1974, later folloued me to NIH as an associate director and to Howard Hughes Medical Institute as a vice president. llFredrickson Installed*l. Institute of Medicine Newsletter, June, 1974, p.1. Files Institute of Medicine. The IOn files also contain the docuaent: I'Excerpts from the collected works of Donald S. Fredrickson (Read aloud on the occasion of his farewell fete)". This hardhearted script was than used by Roger Bulger, and the Mesdames Martha Bloxall and Sarah Brown to Pperform simultaneous dissections in different amphitheaters" of the prose of the second president, using vintage illustrations which include: The inaugural address (May 8, 1974), the "fall meeting notes (Novhr 1974)," a Wamorandun to the abortion study draft (Dee-r i974)e, the +esponse to Sherman (Uarch 1975)", and laletter to Harry Schwartz (April `74). Our bronze plaque was engraved with the following message: II SITE OF WATERGATE Through this door, in the early Morning of June 17, 1972, five men gained urlauful entrance to the offices then occupied by the Democratic National Comsittee and Mere arrested. That act gave the sobriquet Watergate" to a series of subsequent disclosures that culminated in the resignation from office of President Richard M. Nixon on August 9, 1974." Fran Donald S. Fredrickson. IlAesculapian merry-go-rounde,Transactions of the Association of American Physicians, XC, 1977: pp. 59-73. Donald S. Fredrickson. Remarks, NAS, Council of Academy, Dinner in honor of Handler, P. and Mac Lane, S.D., June, 1981, Archives of the National Academy of Sciences. Even after I had returned to NIH as Director, Phil and I occasionally were at odds over the conditions by which the NAS carried out nuserous NIH contracts, differences through uhich our relationship gradually matured. One night in September, 1980, being Wrs of a delegation to Africa under the leadership of Frank Press, Phil and I discovered that we had purchased identical safari jackets in a Nairobi store. Ue celebrated satorical kinship uith a cup of coffee in a screened porch surrOunded by the steemy night and renewed an understanding that uhatever our differences in the early 1011 days, there was no doubt between us that iom memoir dr fredricbon 25 Notes - Page 2 our views on principles of science were convergent. Our last official appearance together uas as the lead-off witnesses to a Congressional hearing on scientific fraud before Mr. Gore (D. Ark) on March 31, 1981. I have a copy of the letter Phil later wrote Mr. Gore, complaining that the latter lacked the necessary understanding of the neture of science. Phil Handler took science and the stances of its premier Academy very seriously. 11. In an op-ed article, 18NIH and leadership. II Uashinaton Post, January 20, 1973, Charles Edwrds, the former Assistant Secretary for Health (who had just resigned to take a position in industry), ackrwledged the resulting dismsy at NIH but defended his action: "the director of NIH must be an advocate for his agency . . but also convey the realities of public policy to the research camnaiity.H 12. Houard Cohen was a ym lawyer serving a %-day detail in the Hite House, assisting the Ford achinistration in its recruiting. Uhen, early in January, Hanft had cane to Roger Bulger with the premature news that Weave just lost our presidenV~, I learned about her well-meaning VarplicityP in my eventual departure. 13. Uhen Uilbur Cohen left the Secretary's post, I mede sure I was in the queue to say goodbye to him; I genuinely liked him and wanted to present him with a box of Schissselpennincks in memory of our sessions. 14. Jim Shannon uas one of those intimately involved in the early activities of the Board on Medicine. He clearly believed that the primary role of the neu 1011 uas that of providing more support for a larger NIH budget. At this meeting, and during my brief reign he didn't conceal from me his disappointment with how often the IDN uas distracted from this mission. 15. Among the matriculation rites attending presidential appointment, the courtesy visits to key me&et-s of Congress and the formal hearing before Senate confirmation of appointment are among the required courses. Selected notes from the Green Diary provide a set of ilrpressions of these events: llArwil 28, Cooper and I meet with Congressman Robert Michel (R Ill), ranking minority me&et- of the House Appropriations Subcomsittee for Labor and Health. Ue were ferniliars, for I had testified before him an institute director in 1967-68. ADril 30 Tim Lee Carter,